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Articles 
Kathleen E. Bainbridge, Howard J. Hoffman, and Catherine C. Cowie Using data from the National Health and Nutrition Examination Survey, 1994–2000, Bainbridge and colleagues found that hearing impairment was twice as prevalent in patients with diabetes than those without diabetes. This association was independent of known risk factors for hearing impairment. Physicians should be especially alert to the benefits of screening persons with diabetes for hearing impairment.
Elbert S. Huang, Qi Zhang, Niren Gandra, Marshall H. Chin, and David O. Meltzer In this decision analysis model to estimate the net benefits of treating to a hemoglobin A1c level of 7% rather than 7.9% among 60- to 80-year-old persons with several different life expectancies, net benefits of tight control ranged from 51 to 116 quality-adjusted days. Benefits decreased with advancing age and as life expectancy decreased, suggesting that the target hemoglobin A1c value can be higher in elderly people with comorbid disease.
Jeanne M. Marrazzo, Katherine K. Thomas, Tina L. Fiedler, Kathleen Ringwood, and David N. Fredricks Bacterial vaginosis often persists after treatment, possibly because of bacterial vaginosis–associated bacteria (BVAB). Among 335 women who have sex with women, Clostridia BVAB1, BVAB2, or BVAB3; Peptoniphilus lacrimalis; and Megasphaera phylotype 2 at baseline and lower adherence to treatment were associated with persistent bacterial vaginosis 1 month after treatment. Microbiological analysis at the time of diagnosis may predict treatment failure.
Improving Patient Care
Robert M. Wachter, Scott A. Flanders, Christopher Fee, and Peter J. Pronovost The administration of antibiotics within 4 hours to patients with community-acquired pneumonia is a widely used, but often criticized, quality-of-care measure. The authors make 5 recommendations for future development of publicly reported quality measures.
Reviews
Eric Bateman, Harold Nelson, Jean Bousquet, Kenneth Kral, Laura Sutton, Hector Ortega, and Steven Yancey Many question whether adding long-acting β-agonists to treatment regimens of patients whose asthma is not controlled with inhaled corticosteroids alone is safe. In 66 GlaxoSmithKline trials involving 20 966 patients with persistent asthma, twice-daily 50-µg salmeterol plus inhaled corticosteroids did not seem to alter risk for asthma-related hospitalizations but decreased risk for severe exacerbations requiring systemic corticosteroids. One asthma-related death and 1 intubation occurred in patients receiving combination therapy.
Perspectives
Jeffrey T. Berger, Evan G. DeRenzo, and Jack Schwartz Many adult patients do not have the cognitive capacity to make decisions and must rely on surrogates. The basis for surrogates' decisions is typically the patients' known wishes, what the surrogate thinks the patient would decide, or the patient's supposed best interests. However, this framework has limitations. The authors review research on surrogate decision making, compare actual practice with normative standards, and offer ways to improve practice.
Clinical Guidelines
Kenneth Lin and Kevin Fajardo Lin and Fajardo's systematic review supports the USPSTF recommendation in this issue on screening for asymptomatic bacteriuria. This article is only available at www.annals.org.
U.S. Preventive Services Task Force The U.S. Preventive Services Task Force (USPSTF) reaffirms their 2004 recommendation to screen for asymptomatic bacteriuria with urine culture in pregnant women at 12 to 16 weeks' gestation or at the first prenatal visit, if later (grade A recommendation). They do not recommend screening for asymptomatic bacteriuria in men and nonpregnant women (grade D recommendation).
Editorials
Keiko Hirose In this issue, Bainbridge and colleagues report that people with diabetes in the National Health and Nutrition Examination Survey had increased risk for hearing loss compared with nondiabetic persons. Their study opens up potential directions for future research, in terms of medical or surgical therapies that may halt the progression of diabetic cochleopathy, whether tighter glycemic control has a protective effect against the development of hearing loss, and the clinical implications of diabetes-related hearing loss.
Kevin B. Weiss In this issue, Bateman and colleagues combined patient data from randomized efficacy trials to determine whether incidence of severe asthma-related events differs in persons receiving salmeterol plus inhaled corticosteroids versus inhaled corticosteroids alone. Although the study is well executed and uses sound methods, the data source has limitations. The best advice in the absence of new data may be to use combination therapy only for indications that accord with nationally accepted clinical guidelines, and to not use long-acting β-agonists as first-line treatment.
The Editors The Editors review changes and accomplishments from the past year at Annals.
On Being a Doctor
David Muller
On Being a Patient
Terry L. Wahls
Letters Does the Revised Uniform Anatomical Gift Act Still Take Care of Organs before Patients?
Association between Protein Levels and Mortality in Patients with Peripheral Arterial Disease
Does Ascertainment Bias Affect Reports on the Incidence of Multidrug-Resistant, Community-Associated Methicillin-Resistant Staphylococcus aureus Infection?
Relevance of Recertification for Primary Care Physicians
Benefits and Drawbacks of Universal Surveillance of Methicillin-Resistant Staphylococcus aureus
Cardiac JAK2 Mutation V617F in a Patient with Cardiomyopathy and Myeloproliferative Disease
Stefan Gattenlohner, Georg Ertl, Hermann Einsele, Stefan Kircher, Hans-Konrad Muller-Hermelink, and Alexander Marx Repeatedly False-Negative Rapid HIV Test Results in a Patient with Undiagnosed Advanced AIDS
This issue provides a clinical overview of acne, focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. | |||||||||||||||||||||||||||||||||||||||||||||||
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